What are the diagnostic criteria and management strategies for polycystic ovarian syndrome (PCOS)?

• A. Hyperandrogenism with ovulatory dysfunction and polycystic ovaries; manage with weight loss, combined oral contraceptives, metformin, and antiandrogens if needed
• B. Hyperprolactinemia with normal ovaries
• C. Thyroid dysfunction with obesity
• D. Hypothyroidism with infertility

Answer: (A)

Polycystic ovarian syndrome is diagnosed when at least two of three features are present: hyperandrogenism (clinical signs like hirsutism or acne, or elevated androgens on lab tests), ovulatory dysfunction (irregular cycles or anovulation), and polycystic-appearing ovaries on ultrasound, after other causes of similar symptoms have been excluded. The option describing hyperandrogenism with ovulatory dysfunction and polycystic ovaries matches these diagnostic components, making it the best description of PCOS.

Management centers on reducing symptoms and metabolic risk. For patients who are overweight, weight loss and regular exercise can improve ovulation and insulin resistance. Combined oral contraceptives help regulate menstrual cycles and lessen androgenic symptoms such as acne and hirsutism. Metformin is used, especially when insulin resistance is present, to improve metabolic parameters and may aid ovulation in some patients. Antiandrogen medications, like spironolactone, can be added if hirsutism persists despite other treatments. If fertility is desired, ovulation induction with agents such as letrozole or clomiphene is commonly pursued, often after addressing metabolic factors. The other options point to different conditions (hyperprolactinemia, thyroid dysfunction, or hypothyroidism) rather than PCOS.